The news broke Friday that Sr. Carol Keehan of the Catholic Healthcare Association (CHA) has broken with the Obama administration's plan to force abortion drugs and contraception on religious institutions such as Catholic hospitals and universities that offer medical insurance.

The dramatic move was announced in a 5-page letter (PDF here) signed by Keehan and two CHA board members.

The move is momentous because Keehan famously broke with the U.S. bishops to endorse the original passage of the administration's Affordable Care Act ("Obamacare") and then broke with them again to endorse the Department of Health and Human Services abortion drug and contraception mandate, providing political cover for the administration.

Both acts were widely criticized, and it appeared to many that Sr. Keehan was a willing tool of the administration's "divide and conquer" strategy for dealing with the Catholic community--playing the role of an alternative Catholic authority that could be pitted against and thus neutralize the voice of he bishops.

But she is not so willing today, it seems, and the new move must come across to the administration as an act of betrayal of it and its agenda.

In the letter, Keehan makes two principal points:

1) The unprecedented and excessively narrow definition of what counts as a religious employer that the HHS mandate contains needs to be broadened.

2) If the administration wants people to have free abortion drugs and contraception, it should pay for them directly, without the direct *or indirect* involvement of religious employers.

With regard to the first point, Keehan proposes that a religious employer be defined not just as a church but also as

An organization is associated with a church if it shares common religious bonds and convictions with the church.

She argues that

This approach would align the policy under the women’s preventive care regulation with existing federal law on conscience protection. The exemption in the final rule is narrower than any conscience clause ever enacted in federal law and reflects an unacceptable change in federal policy regarding religious beliefs.

And that

Making this change could help address the serious constitutional questions created by the Departments’ current approach [note the implication that this may make the HHS mandate unconstitutional, a signal of how it may be challenged in court--ja], in which the government essentially parses a bona fide religious organization into secular and religious components solely to impose burdens on the secular portion.

To make this distinction is to create a false dichotomy between the Catholic Church and the ministries through which the Church lives out the teachings of Jesus Christ. Catholic health care providers are participants in the healing ministry of Jesus Christ.

Our mission and our ethical standards in health care are rooted in and inseparable from the Catholic Church and it's teachings about the dignity of the human person and the sanctity of human life from conception to natural death.

Regarding the second point, Keehan states that

The more we learn, the more it appears that the [HHS mandate] approaches for both insured and self-insured plans would be unduly cumbersome and would be unlikely to adequately meet the religious liberty concerns of all of our members and other Church ministries.

Given this, if the Departments unfortunately continue to pursue the course that all employees must have access to contraceptive services without cost, then the government will need to develop a way to pay for and provide such services directly to those employees who desire such coverage without any direct or indirect involvement of religious employers (under the expanded definition described above.)

Precedent for federally provided access to contraception can be found in the Title X program and in the Medicaid family planning waivers. The ANPRM also suggests the possible creation of a program under which OPM provides contraceptive coverage through a multi-State policy offered on the State exchanges.

This kind of section is troubling in that it gives the appearance of telling someone how they can go about doing an evil act ("If you want to do this evil thing, follow these simple instructions . . . "). On the other hand, it can be read as simply a way of saying, "If you want to do this evil act, do it without me."

In principle, such appeals can be legitimate, but the longer and more detailed the appeals are, they more they look like instructions on how to commit evil acts.

Keehan also notes:

Among the drugs approved by the FDA for use as a contraceptive is ulipristal acetate, commonly known as “ella.” Studies of ulipristal’s mechanism of action have indicated that the drug can interfere with implantation of a fertilized egg. The Catholic Church considers a drug which interferes with the implantation of a fertilized egg to be abortifacient, based upon the known science of reproduction and the Church’s belief that human life begins at the moment of fertilization.

And she states:

As the representative of Catholic hospitals and health care providers, which will be impacted in their role as employers, CHA focuses its comments on this aspect of the [HHS mandate].

We acknowledge, but will not address here the issues about whether the mandate itself is constitutional and whether it should apply to other entities, such as, insurers or individuals.

The United States Conference of Catholic Bishops has persuasively addresses these points it its comment letter.

She also states that the CHA has not been silent on these issues in the past:

On August 1, 2011 HRSA issued . . . an Interim Final Regulation (76 Fed. Reg. 46621) proposing to create an exemption to the contraceptive coverage requirement for certain religious employers, defining the term “religious employer” so narrowly as to exclude Catholic hospitals and health care organizations as well as other religious institutional employers.

CHA objected strenuously to the inappropriately narrow definition in its comment letter date September 22, 2011 and objected again when it was announced in January 2012 that the Administration would not make any changes to the definition.

Okay, fine, but when the Obama administration proposed the tweak to its policy in February that would create the impression that religious employers were not directly paying for such services, Keehan was sounding pretty rosy on the idea, stating on Feb. 10:

The Catholic Health Association is very pleased with the White House announcement that a resolution has been reached that protects the religious liberty and conscience rights of Catholic institutions. The framework developed has responded to the issues we identified that needed to be fixed.

We are pleased and grateful that the religious liberty and conscience protection needs of so many ministries that serve our country were appreciated enough that an early resolution of this issue was accomplished. The unity of Catholic organizations in addressing this concern was a sign of its importance.

This difference has at times been uncomfortable but it has helped our country sort through an issue that has been important throughout the history of our great democracy.

CHA and its members were profoundly disappointed to learn that the definition of a religious employer was not going to be broadened in the U.S. Department of Health and Human Services' rules for preventive services for women.

The impact of being told we do not fit the new definition of a religious employer and therefore cannot operate our ministries following our consciences has jolted us. The contributions of Catholic health care, education and social services to this country's development are legion. They have responded to the needs of all, not just Catholics. They have been delivered by many who do not share our faith, but share our commitment.

From President Thomas Jefferson to President Barack Obama, we have been promised a respect for appropriate religious freedom. The first amendment to our Constitution affirms it. We are a pluralistic country, and it takes respectful dialogue to sort this out fairly. This decision was a missed opportunity.

CHA has expressed concern and disappointment about this on behalf of the ministry. We have said the problem is not resolved, and we must have a national conversation on this. CHA is working closely with the United States Conference of Catholic Bishops, Catholic Relief Services, Catholic Charities USA, the Association of Catholic Colleges and Universities and others to look at options to resolve this. We will be discussing it at the CHA board meeting on Feb. 8.

I assure you that we will use the time to pursue a correction during the one-year extension. We will give this issue priority and consult with members and experts as we evaluate options to deal with this. Any suggestions, comments or questions are welcome. I promise to keep the membership informed as we move along in this effort. Please keep this important effort in your prayers as well.

So Keehan's history on this subject--while by no means what it should be--is more complex than the impression created by Obama administration and the mainstream media. (You're surprised by this?)

It is, however, fortunate that she has come out publicly against the HHS mandate as it stands.

It is unfortunate that this happened on a Friday, when the Eye of Mordorthe Media was turned elsewhere.

Let's make sure it doesn't die as a Friday story but sticks around and has some real impact.

In other words: Share with friends, blog, email, whatever! Let's get the word out!